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Pleural Effusion overview & Definition

In Pleural effusion, an excess amount of fluid accumulates around the lung. The fluid accumulates in the pleural space that is an area between the layers of the tissue that lines the lungs and the chest cavity. It is also known as effusion or pulmonary effusion. It can occur due to many medical conditions and your doctor provides the treatment as per the underlying cause of pleural effusions. The fluid that builds up around the lungs causing pleural effusion may be categorised as either exudate or transudate. The fluid types which cause the phenomenon are as follows:

-  Transudate fluid: Transudate fluid is an ultrafiltrate of plasma. This fluid occurs due to vascular hydrostatic imbalance and oncotic forces in the chest including heart failure, and cirrhosis. Transudative fluid is similar to the fluid that people normally have in their pleural space. Liquid leaking across normal pleura forms this fluid. It is not required to drain the fluid in this type of pleural effusion unless it is very large. This type of pleural effusion generally occurs due to congestive heart failure.

-  Exudate fluid: Exudate fluid typically occurs due to inflammatory conditions including lung infection and malignancy. Exudative pleural effusions are generally more serious and hard to treat than transudate pleural effusions. This type of pleural effusion is required to be drained as per the size of pleural effusion and inflammation involved.

Pleural Effusion Symptoms:

You generally experience the symptoms or signs of pleural effusions when it is moderate, large-sized or in case inflammation exists. When it is small-sized, you may not be able to experience the symptoms of pleural effusions. Check out various symptoms associated with pleural effusions:

- Pain in the chest

- Difficulty in breathing

- Worse pain during breathing (pleurisy)

- A dry cough or a productive cough

- Shortness of breath

- Fever

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Causes of Pleural Effusion:

A pleural effusion can happen due to various reasons. Check out some of the common reasons that can cause a pleural effusion:

- Pulmonary embolism which occurs due to blockage of an artery in the lungs can be a cause of pleural effusions.

- Infections such as pneumonia or tuberculosis may lead to a pleural effusion.

- Autoimmune conditions including lupus or rheumatoid arthritis can lead to accumulation of fluid around the lungs.

- Lung cancer and other cancers that can affect the lung or pleura can cause fluid accumulation in the pleural space.

- Congestive heart failure, a condition when your heart is not able to pump the blood properly to all your body parts, can lead to pleural effusions.

- Various diseases of the kidney and liver can lead to accumulation of fluid in your body which can leak into the pleural space causing a pleural effusion.

- Hypoalbuminemia and trauma are the other causes that can lead to pleural effusions.

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How is it diagnosed?

As soon as you discover the symptoms of pleural effusions, you should reach out to the best doctor around you. Your doctor will conduct a physical examination to diagnose the problem. He will ask you about the symptoms you are experiencing and medical history. If a person has a history of congestive heart failure or cirrhosis (a liver problem) with the signs of a cough, fever, chest pain and more then the person may have a problem of pleural effusions. Your doctor will listen to your chest with a stethoscope and also tap on your chest. Though, doctors only confirm pleural effusions after doing the imaging tests. Your doctor may ask you to get these tests done in order to diagnose a pleural effusion:

-  Chest X-ray: Chest X-rays are very helpful in detecting pleural effusions. In chest X-ray, pleural effusions appear white while the airspace appears black. Pleural effusions can occur on only one side which is unilateral or both sides which is bilateral. The X-ray also helps to see the movement of pleural effusions while a person lying on their side. For this, your doctor will ask you to lie on your side for a few minutes. It helps to know whether the fluid flows freely within the pleural space.

-  Computed tomography (CT scan): It is an imaging procedure done to take X-rays quickly. In this, computer constructs various images of the chest from inside and out. This test is more helpful as it gives more details than the chest X-ray. This test helps to know the possible cause and extent of pleural effusion.

-  Ultrasound: Ultrasound is done to find the location of fluid so that doctor can get a sample for analysis. The inside images of your body appear on a video screen that helps the doctor to locate the fluid.

In order to diagnose the cause, firstly a doctor determines whether the fluid is transudate or exudate. This helps the doctor to diagnose and provide the treatment properly.

Prevention from Pleural Effusion:

There is no way to prevent pleural effusions. But you can reduce the risk of developing a pleural effusion. Pleural effusions can be prevented by preventing the underlying causes of pleural effusions. As soon as you experience any or some of the symptoms of pleural effusions, you should see a doctor for early and prompt treatment. Check out various ways that will help you to reduce the risk of developing pleural effusions:

- You should quit smoking.

- You should reduce the consumption of alcohol.

- Pneumonia, an infection in one or both lungs, can lead to pleural effusions. You should reach out to your doctor for the early treatment of pneumonia so that it does not lead to pleural effusions.

- Make changes in your lifestyle for preventing heart failure including a healthy diet, be physically active, reduce or avoid the intake of caffeine, maintain your weight and more.

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Treatment of Pleural Effusion:

If you are suffering from pleural effusions then you should book an appointment with the best doctor for an early treatment. It can lead to complications if not treated properly on time or left untreated. The treatment depends on the underlying cause due to which you are suffering from pleural effusions. As soon as your doctor discovers the cause, the treatment will be started accordingly. If the cause is pneumonia then your doctor would prescribe you antibiotics or if it is congestive heart failure then diuretics would be given to you in the treatment. If the pleural effusions are large, infected and inflamed then they are drained so that you can feel better and other complications can be avoided. Check out the various treatment options available for pleural effusions:

-  Thoracentesis: Thoracentesis is also called as a pleural tap. This procedure is used when the pleural space has too much fluid. It is generally used when your pleural effusion is large. Your doctor withdraws more fluid than required for testing in order to ease your symptoms. A needle is inserted into the pleural space to withdraw the fluid.

-  Tube thoracostomy (chest tube): In this treatment procedure, your doctor makes a small cut in your chest wall. A plastic tube is inserted through this cut into the pleural space to drain the fluid. It is done for several days. Some complications are associated with this treatment option. Anxiety, shortness of breath, cough and more are some of the complications. The patient can feel chest tube related pain which ends once the tube is removed. In some cases, chronic pain can also occur due to induced scarring of the intercostal space.

-  Pleural drain: If a pleural effusion keeps coming back or is frequent then your doctor may prescribe you to get a long-term catheter inserted. It would be inserted through your skin into the pleural space to drain the excess fluid. This can be easily done at the home. Your doctor will guide you about how to do and when to do that.

-  Pleurodesis: In pleurodesis treatment option, a doctor injects an irritating substance including talc or doxycycline. This substance is injected through a chest tube into the pleural space. This substance is injected to inflame the pleura and chest wall due to which they bind to each other tightly as they heal. In many cases, pleurodesis is very helpful as it prevents pleural effusions from coming back or being frequent.

-  Pleural decortication: In this medical treatment, doctors remove the dangerous inflammation and unhealthy tissue surgically. For reaching to the pleural space, your doctor may do the small cuts (thoracoscopy) or a large one (thoracotomy).

Thoracentesis, Tube thoracostomy (chest tube), Pleural drain, Pleurodesis and Pleural decortication are some of the treatment options available for treating the people suffering from pleural effusions. The treatment option is determined after a careful study of the cause of pleural effusions, medical history and more. It is important that one gets the right treatment at the right time. Otherwise, it could lead to various complications.

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Complications

Check out various complications associated with pleural effusions:

- If a person is suffering from pleural effusions for a long period of time then it can lead to lung scarring and permanent decreases in lung function.

- If fluid remains for a long period of time then it may become infected leading to pleural empyema. In pleural empyema, pus gets collected in the pleural cavity due to microorganisms, usually bacteria.

- The medical treatment option of tube thoracostomy (chest tube) is associated with various complications. Anxiety, shortness of breath, and cough are the minor complications that one may experience in this treatment. In this, a chest tube is inserted into the pleural space for several days which can cause the chest tube related pain to the patient. This pain generally ends once the tube is removed. In some cases, patients feel chronic pain which is common. The chronic pain occurs due to induced scarring of the intercostal space.

- Pneumothorax is a potential complication of pleural effusions. Pneumothorax occurs when air leaks into the pleural space due to which lung collapses.

- Sometimes, pleural effusions are frequent or reoccur multiple times. In such cases, pleurodesis treatment method is used to prevent pleural effusions from coming back. There is a possibility that this method does not work then the only option left is surgery.

Conclusion

In a pleural effusion, fluid builds up in the pleural space or around the lung. Pleural space is an area between the layers of tissue that line the lungs and the chest cavity. There are two types of fluid including exudate and transudate. Chest pain, difficulty in breathing, pain during breathing (pleurisy), dry cough or a productive cough, shortness of breath and fever are the various symptoms or signs of pleural effusion. The possible causes of pleural effusions are congestive heart failure, hypoalbuminemia, pulmonary embolism, trauma, various diseases of kidney and liver, lung cancer and other cancers and infections. As soon as you experience the symptoms of pleural effusion, you should reach out to the best doctor around you. The treatment of pleural effusion totally depends on the underlying cause. Thoracentesis, Tube thoracostomy (chest tube), Pleural drain, Pleurodesis and Pleural decortication are the medical treatment options available for people suffering from pleural effusions. A pleural effusion can lead to serious complications if left untreated or not treated properly.

If you are looking for the answers to various questions including:

- What is a pleural effusion?

- What are the symptoms, causes and, complications of pleural effusion?

- How pleural effusion is diagnosed, treated, and prevented?

Then you are at the right place, please do read all the information given above to know more!

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Last updated on : 26-10-2018

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